Circumcision Pros and Cons

Critics
According to a comprehensive study, newborn responses to pain are
"similar to but greater than those observed in adult subjects."
Circumcision is overwhelmingly painful and traumatic. Some infants do
not cry because they go into traumatic shock from the overwhelming pain
of the surgery. No experimental anesthetic has been found to be safe
and effective in preventing circumcision pain in infants. Changes in
pain response due to newborn circumcision have been demonstrated at six
months of age, suggesting lasting neurological effects and a symptom of
post-traumatic stress disorder.

COMPLICATIONSAdvocates
Circumcision has low risk, less than 1%. Most complications are bleeding and infection.

Critics
The true incidence of complications is unknown. The rate of surgical
complications was reported to be from 0.2 to 38 percent. (The higher
rate included complications reported during the infants' first year.)
Realistic short-term complication rates are between 2-10%. There are
over 20 known short-term complications, including bleeding, infection,
surgical injury, and in rare cases, death. This does not include
complications discovered later in life, problems caused by circumcision
but not attributed to circumcision, or unrecognized harm.

INFANT BEHAVIORAL RESPONSEAdvocates
This aspect of circumcision is not discussed by advocates.

Critics
Various studies have found that short-term effects of circumcision
include changed sleep patterns, activity level, and mother-infant
interaction, more irritability, and disruptions in feeding and bonding.

URINARY TRACT INFECTION (UTI)Advocates
According to a meta-analysis, circumcision reduced the risk of
developing UTI in the first year of life by a factor of 12, and the
absolute risk of a genitally intact boy developing UTI was
approximately 1 in 100.

Critics
The methodology for studies claiming that circumcision reduces the risk
of UTI complicates making any conclusion. They do not account for
confounding variables such as breastfeeding, urine collection method,
definition of UTI, and rooming in. For a rate of 1%, 100 boys would
have to be circumcised to prevent one UTI, which might be prevented by
breastfeeding or rooming in. A Japanese study of 603 boys who were not
circumcised did not find one case of UTI. This further suggests
methodological problems with attempts to claim a strong association.
UTI is easily treatable with antibiotics.

PENILE CANCERAdvocates
Reports of several case series noted a strong association between lack of circumcision and penile cancer. Advocates believe that "invasive penile cancer could be virtually eliminated in the United States by routine newborn circumcision."

Critics
There are no American studies of the incidence of penile cancer and its
association with circumcision status. Penile cancer is rare, and the
estimated American incidence is about 1 per 100,000. In other developed
countries where circumcision is rare, such as Denmark and Norway, the
incidence of penile cancer is lower than the estimated American rate.
Penile cancer occurs generally in elderly men. Therefore, a male may
make a decision to be circumcised when he is older without losing this
claimed benefit.

SEXUALLY TRANSMITTED DISEASESAdvocates
Based on a meta-analysis of published studies, genitally intact men had
approximately 3 times the relative risk for HIV infection and increased
risk for genital ulcer disease. (Many HIV studies were done in Africa.)
A review article concluded that genitally intact men were 2 to 8 times
more likely to become infected with HIV. Circumcision reduced the risk
of genital ulcer disease, including syphilis and chancroid.

Critics
Studies are conflicting for each sexually transmitted disease. Sexually
transmitted diseases and circumcision involve behavior, hygiene
practices, culture, and religion, and it is impossible to control all
the confounding variables that affect sexual behavior and circumcision
status. Circumcision may increase the risk of developing gonorrhea and
chlamydia. A literature review concluded, "Based on the studies
published to date, recommending routine circumcision as a prophylactic
measure to prevent HIV infection in Africa or elsewhere, is
scientifically unfounded." In a study on transmission rates of HIV from
infected males to uninfected females and from infected females to
uninfected males in Uganda, the authors found that circumcision status
was not a significant factor in the risk of transmission. Sexually
transmitted diseases obviously cannot be transmitted until an
individual engages in sexual activity. Therefore, a male may make a
decision to be circumcised when he is older without losing this claimed
benefit.

Critics
The difference in reported sexual dysfunction above is not
statistically significant. The Williamson study consists of young,
Midwestern, 98% white mothers. They live in an area of the country with
the highest circumcision rate, and 78% of the group had no experience
with genitally intact men.

In a more recent survey, women with longer dual experience preferred
anatomically complete men overwhelmingly to circumcised men. Without
the foreskin to provide a movable sleeve of skin, intercourse with a
circumcised penis resulted in decreased vaginal secretions, more
vaginal discomfort, harder and deeper thrusting of the partner, less
chance of having an orgasm, less frequent orgasms, less frequent
multiple orgasms, and shorter duration of coitus.

Circumcision results in a significant loss. The foreskin is an
integral, normal part of the penis. It protects the head of the penis
and is comprised of unique zones with several kinds of specialized
nerves that are important to optimum sexual sensitivity. Investigators
found that circumcision removes about one-half of the erogenous tissue
on the penile shaft. The foreskin on the average adult male is about 12
square inches of highly erogenous tissue. Men circumcised as adults
reported a significant loss of sensitivity.

A description of the complex nerve structure of the penis explains why
anesthetics provide incomplete pain relief during circumcision. Cutting
off the foreskin removes many fine-touch receptors from the penis and
results in thickening and desensitization of the glans outer layer. The
complex anatomy and function of the foreskin dictate that circumcision
should be avoided or deferred until the person can make an informed
decision as an adult.

In a national survey, circumcised men reported they were more likely to
engage in masturbation, heterosexual oral sex, and anal sex than
genitally intact men. The result suggests that circumcised men seek
alternative forms of stimulation to compensate for reduced sensitivity.

A poll of circumcised men described adverse outcomes on men's health
and well-being. Findings showed wide-ranging physical, sexual, and
psychological consequences. Some respondents reported prominent
scarring and excessive skin loss. Sexual consequences included
progressive loss of sensitivity and sexual dysfunction. Emotional
distress followed the realization that they were missing a functioning
part of their penis. Low-self esteem, resentment, avoidance of
intimacy, and depression were also noted. Male satisfaction with
circumcision depended on knowledge about circumcision. The more men
knew, the more likely they were to be dissatisfied. They wished they
had a choice.

Circumcision is traumatic, and the long-term psychological effects of
circumcision are similar to the long-term effects of trauma. Using four
case examples that were typical among his clients, a practicing
psychiatrist presented clinical findings regarding the serious and
sometimes disabling long-term somatic, emotional, and psychological
consequences of infant circumcision in adult men. These consequences
resembled complex post-traumatic stress disorder and emerged during
psychotherapy focused on the resolution of perinatal and developmental
trauma. Adult symptoms associated with circumcision trauma included
shyness, anger, fear, powerlessness, distrust, low self-esteem,
relationship difficulties, and sexual shame.

ETHICSAdvocates
Ethical issues are not discussed by advocates.

Critics
When circumcision is performed, it does not treat any disease, injury,
or other health problem. Since there is no urgency to do it, it must be
delayed until the child is old enough to make the decision for himself.

Circumcision violates a major principle of medical practice: First, do
no harm. According to a journal article, it also violates all seven
principles of medical ethics. Some doctors and nurses refuse to perform
or assist with circumcisions because of ethical considerations. They
have organized to form Doctors Opposing Circumcision and Nurses for the
Rights of the Child.

The AAP Committee on Bioethics report states, "Pediatric health care
providers. . . have legal and ethical duties to their child patients to
render competent medical care based on what the patient needs, not what
someone else expresses. . . .[T]he pediatrician's responsibilities to
his or her patient exist independent of parental desires or proxy
consent." See also Response to American Academy of Pediatrics Policy Statement.

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